Disabling overactivity of the extensor hallucis longus after stroke: clinical expression and efficacy of botulinum toxin type A.

OBJECTIVES

To describe the clinical characteristics of persistent extension of the great toe related to overactivity of the extensor hallucis longus (EHL) after a stroke and to explore the efficacy of treatment with botulinum toxin type A.

DESIGN

Case series.

SETTING

A physical medicine and rehabilitation department in France.

PARTICIPANTS

Eleven patients with hemiplegia disabled by overactivity of the EHL were classified according to the different ways in which that overactivity was triggered. Disability was related to pain in 5 patients, to shoe difficulties in 10 patients, and to varus foot in 6 patients.

INTERVENTION: Injection of botulinum toxin type A into the EHL.

MAIN OUTCOME MEASURES: Efficacy was assessed on day 15 by triggering of pain, shoe difficulties, and varus deformity and by patients' subjective assessment on day 15, at 3 months, and at 6 months.

RESULTS

On day 15, EHL overactivity disappeared after 16 of the 18 injections in 10 patients; subjective assessment was very good for pain and shoe difficulties and remained good or very good at 3 months for 8 patients who received 12 injections.

CONCLUSION

Botulinum toxin type A is effective in treating disability related to poststroke overactivity of the EHL.